Jenda: A Journal of Culture and African Women Studies (2001)
ISSN: 1530-5686
RESENSITIZING AFRICAN HEALTH CARE AND POLICY PRACTITIONERS: THE GENDERED NATURE OF AIDS EPIDEMICS IN AFRICA
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Jenda: A Journal of Culture and African Women Studies (2001) ISSN: 1530-5686 RESENSITIZING AFRICAN HEALTH CARE AND POLICY PRACTITIONERS: THE GENDERED NATURE OF AIDS EPIDEMICS IN AFRICA |
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Ifeyinwa Umerah-Udezulu
This essay contributes to discussions surrounding the spread of HIV/AIDS among African women by offering gender-based public policy perspectives. It analyzes the pandemic nature of the AIDS crises globally, and evaluates the geographical distribution of the infection among women in Africa. Furthermore, it analyzes the causes and sociological consequences of AIDS, reviews the roles played by diverse groups to combat the problems of this deadly disease. It argues substantively, that health care deliverers and governments can play better and crucial roles to manage the spread of this disease. Finally, it offers policy prescriptions to resolve these multifaceted crises.
According to UNAIDS data, there were about 33.6 million people (including 1.2 million children under the age 15) infected with the AIDS/HIV virus (UN Yearbook, 2000). In 1999, there were about 5.6 million new cases of AIDS and about 16.3 million have died since the AIDS epidemic emerged (UNAIDS/WHO, 1999). The date reveals that about 14.8 million women of 46 percent have been infected out of the 32.4 million cases. The most affected age group range from 15 to 49 years. Half of the AIDS mortality cases are women, which equals about 12.7 million cases (UNAIDS 1999). The data show that women have become the main victims of the AIDS crisis and are now classified as a high-risk group. The disease is currently spreading faster among women than men, even though transmission is most likely by heterosexual contact. The majority of AIDS infection is largely through husbands/wives sexual contacts, heterosexual relations, homosexuality, prostitution, blood transfusion, mother to infants through placenta and breast feeding, and through contaminated blood and blood products. Whichever the avenue through which many African women become infected, they have fallen victims of AIDS, a situation that have caused them to be victimized and stigmatized.
Seventeen years after the discovery of the human immunodeficiency virus (HIV), thousands of people from all over the globe converged in Durban South Africa to attend the XIII International AIDS Conference in July 2000. The conference, which placed major emphasis on the pandemic nature of AIDS, released the prevalence data of 34.3 million cases worldwide. Africa accounts for 24.5 million of these cases, which amount to 71.4 percent. The data also claim that about 2.8 million people have died in Africa since the start of the epidemic. According to the Durban declaration, if the current trend prevails, Southeast Asia, South America, Russia and its satellite republics, will also bear the burden in the next two decades (Russell, S. 2000). The conference called on respective governments and Western countries to jointly combat the AIDS epidemic. African leaders, civil society, and private sectors were strongly encouraged to prioritize the issues of HIV/AIDS epidemic in their respective countries and communities.
Due to sub-standard health care systems and lack of economic and political stability, the developing countries are the hardest hit by the AIDS crisis. According to the UN estimate, these areas account for 95 percent of AIDS cases and 97 percent of new infection rates in 1999. Africa in general is classified as the epicenter of the pandemic. This area is associated with over 70 percent of all the AIDS cases in the world. It accounts for 22.5 million, representing two-third of the 33.6 millions cases of global infections. Even though, some African heads of states are yet to publicly acknowledge it, AIDS is classified as the leading cause of death for all age groups in the region. Available data in 1999 suggests that 5,500 AIDS- related deaths occur daily. About 11,000 people contract this deadly disease every 8 seconds (Thurman, 1999). The areas hardest hit are the impoverished regions where access to treatment is low and unaffordable.
According to the UNAIDS regional figures of men and women exposed to the disease, African men account for 10.1 million cases out of which the number of women cases is projected to be 12.2 million cases. Estimates suggest a 20 percent annual infection rate (Susser and Stein, 2000). Women accounted for 55 percent of all cases in Africa. For instance, the current infection rate for African women is 12-13 cases for every 10 African men (UN: World’s Women, 2000). The UN report named Zimbabwe and Botswana as having the highest prevalence for AIDS/HIV cases. In Western Kenya, it is established that about 25 percent of young women from ages 15- 19 are infected with HIV, as opposed to men with only 4 percent rate. In Zambia, the HIV/AIDS is higher for young women than young men (UNICEF, 1999). In the Hlabisa Health District of KwaZulu/Natal, South Africa accounted for 42 percent prevalence rate (Wilkinson, 2000). Women in that area had the highest rate of infection.
Most African countries lack a comprehensive mortality surveillance system. Tanzania, in 1992 established the Adult Morbidity and Mortality Project (AMMP). The program sought to establish cause-specific death rates among adults in three areas of the country and then link the data with the statistical evidence generated by the community-based mortality surveillance in order to better manage and coordinate health care delivery in the system. The data was derived from the relatives of the deceased and caretakers. Figures from the AMMP established that the leading cause of death in Tanzania from 1992-1998, was Human Immunodeficiency Virus infection and Acquired Immuno-Deficiency Syndrome. Other causes of death include tuberculosis (Bleed, Dye and Raviglione, 2000), malaria, and diarrhea. Dar-es-Salaam’s gender-sensitive data for HIV/AIDS-related deaths for the 15-29 years age bracket showed high mortality rates of 325 and 154 for females and males per 100,000 population respectively. AIDS mortality rate was highest among the 30-44 age group with rates of 882 and 608 per 100,000 for females and males respectively. Mortality rate was slightly higher for men than women in the 45- 59-age bracket indicating 454 and 591 for females and males respectively. In all, the cumulative HIV/AIDS age and gender-specific AIDS mortality rates for males and females in the region stood at 1353 and 1661 per 100,000 population respectively. The above data highlights the immensity of the HIV-related problems currently confronting the female population in Africa. The hardest hit age groups are those in the productive/reproductive range, falling within the age bracket of 15-29 and 30-44. Mortality rate was slightly higher for men than women in the ages 45-59 bracket.
AIDS has different modes of spread and like other endemic health problems prevalent in the continent is dominant among the underprivileged and impoverished communities. HIV-1 that is responsible for the AIDS pandemic is a retrovirus closely related to a simian immunodeficiency virus (SIV) that infects chimpanzees. HIV-2 that is prevalent in West Africa has also manifested in Europe and India is indistinguishable from an SIV that infects sooty manabey monkeys. Although HIV-1 and HIV-2 were initially isolated from the zoonose (infection transmitted from animals to human) both now spread among the humans through sexual contacts, from mother to infants (breast feeding/placenta), and through contaminated blood and blood products. An animal source for infection is not unique to HIV. For instance, plague originated from rodents and influenza from birds. The new Nipah virus in Southeast Asia reached humans via pigs. Various Creutzfield-Jacob diseases in the United Kingdom are identical to mad cow disease. Once HIV became established in humans, it soon followed human habits and movements. Like many other viruses, HIV recognizes no social, political, or geographic boundaries (Ewald, 1992).
Evidence that AIDS is caused by HIV-1 or HIV-2 has been established even though some scientists and some African leaders still contest the issue. Research on the incidents of AIDS draw the following conclusions:
In different areas of the world, HIV/AIDS can show altered patterns of spread and symptoms. In Africa for example, people infected with HIV are 11 times more likely to die within 5 years and more than 100 times more likely than uninfected people to develop Kaposis Sarcoma, a cancer linked to yet to another virus. As earlier mentioned, compared to men, African women have the fastest rate of HIV/AIDS infection and consequently higher mortality rate. As with any other chronic infection, various factors have a role in determining the risk of the disease. Normally, people who are malnourished, who are older, tend to be more susceptible to the rapid development of AIDS following HIV infection. Nonetheless, in Africa, the reverse is the case. The rate of infection is fastest among young women. However, none of these factors weaken the scientific evidence that HIV is the sole cause of the AIDS epidemic. In the global emergency, prevention of HIV infection must be our greatest worldwide public-health priority. The knowledge and tools to prevent infection are available and must be made available to all AIDS victims, especially women.
Because of the deadly nature of AIDS on women and girls in Africa, many analysts have come to argue that AIDS is a form of mass femicide (Russell, 2001). According to some of these writers (Relly, 2001 and Schoof, 1999), there is a linkage between male domination and the spread of AIDS in Africa. In their view, femicide emerged from a number of gender-related factors: male sexism and domination, genital surgery, and rape. As earlier stated, two third of the global incidents of AIDS are found in Africa. Seven Southern African countries including South Africa have the highest infection rate with the incidence affecting at least one fifth of the adult population. Because of the epidemic proportion of this disease, critics have argued that many AIDS cases manifest as a result of the irresponsible sexual behaviour of African men, who are unfaithful to their spouses and who do not practice safe sex by using latex condoms (Relly, 2000 and Schoof, 1999). The thousands of African women who are subsequently infected with HIV/AIDS encounter isolation and neglect. As a result, they may not reveal their predicament to others for fear of being ostracized (Abdoulaye, 1998). This worsens their situations and prevents them from seeking treatment that would have prolonged their lives.
Some critics have contended that there is a linkage between AIDS and male domination in Africa. In “Death and the Second Sex” (1999), Mark Schoof associates femicide to male dominance. He argues that the spread of AIDS among Southern African women involves the controversial “dry” sex that compromises women’s lives as they seek to pleasure men. These women dry out their vaginal walls with detergent, salt, cotton or shredded newspaper to create a dry environment for sexual intercourse. The dryness causes vaginal lacerations during intercourse and suppresses the uterus’s natural bacteria, which then leads to higher rates of infections and contributes to the spread of HIV/AIDS. Even when condoms are used, women still risk becoming infected because condoms may slip or tear due to excessive friction in the dry vaginal environment. When we consider that in Zimbabwe, for instance, women are not expected to initiate sexual intercourse and girls are socialized to defer sexual decisions to men, these young women are discouraged from raising the issue of safe sex. They are further victimized when social pressures compel them to engage in the dangerous practice of “dry” sex. According to Schoof, it is unfortunate that these women risk infection and even death to please their men (1999). This connection between AIDS and male domination arises when the following variables intervene:
Associated with the problem of male dominance is that of polygamous mentality. This manifests when men have multiple partners rather than marrying many wives, given that polygamy is outlawed in many African countries. Some women too increase their risk factor by having multiple sex partners. Some of these women may be engaged in sex work, some of them are not but they have one or more “sugar daddies.” The “sugar daddy” phenomenon is linked to the main cause of AIDS among teenage girls (Shaw, A, 1999). For a variety of reasons not unconnected with financial insecurity, some of these young impressionable girls enter into sexual relationships with older married men who in return, furnish them with money or luxury items. Because these relationships are not monogamous and involve economic power manipulation, these young women have unprotected sex with “sugar daddies” and may become victims of AIDS.
This type of female surgery is practiced in about 28 African countries. Circumcisions can be initiated right from birth to teenage years. There is no direct connection of this practice to the spread of AIDS in Africa because, parts of Northern Africa where this custom prevails, have the lowest infection rate on the continent. Also, in countries like Uganda and Zimbabwe, where female and male circumcision are lacking, there is a high incidence of HIV/AIDS (Caldwell, 1993). Nonetheless, in cases and in countries where the surgeries are poorly performed, contaminated surgical equipments are used that increases the risk factor. Also, the genital bleeding that occur during intercourse which may lead to HIV/AIDS infection for both genders (Dorkenoo, 1999).
South Africa has the highest rate of rape in Africa. Reports indicate that a women in South Africa is five times more likely to be raped than in any other part of Africa. The high incidence of AIDS makes rape increasingly dangerous (Coomarswamy, 1997). High rape cases are associated to high HIV/AIDS incidence in South Africa. St. John reports that about five insurance companies in South Africa currently sell policy to cover antiretroviral medications for thirty days following rape (1999). Rape is undoubtedly classified as femicide when a male perpetrator is HIV/AIDS positive and is fully aware of the deadly consequence of his actions.
Based on a random study of 1,000 men and 1,000 women by the UNAIDS in Zambia, Cameroon, Kenya and Benin, the prevalence of the virus in young girls is a major source of concern. The study showed that the younger a girl was when she had her first sexual contact, the more likely it is that she has contracted AIDS. This is because the partner may be HIV positive and not know it; or she may have been raped by an HIV positive man seeking a cure for AIDS (Shaw, 1999). The high incidence of rape of young girls in South Africa, for example, is connected to the distorted view among perpetrators that this is a cure for the disease. Acting on this myth, many sexually active HIV positive men perceive young girls as sexually safe and believe that sex with them, particularly a virgin would produce the desired cure for the disease. Without doubt, this unconscionable conduct fails to consider the atrocious and devastating impacts of rape on young female children.
A number of factors combine to affect the spread of AIDS in Africa. These include, but are not necessarily restricted to the following: global tourism, armed conflict and the displacement of people, military personnel, low health care budget, inadequate health care system, lack of drugs, poor sex education, intravenous drug users, heterosexual relationships, homosexuality, prostitution/sexual workers, homelessness, poverty, sexual violence and abuse including multiple sex partners, etc. The following discussion concentrates on migration/refugee crisis, insufficient health care systems, lack of sex education, the spread of HIV/AIDS in Africa due to prostitution/sex workers, breast-feeding, and childbirth.
According to the World Health (1999), the past two decades have experienced a sharp increase in migration pattern. Some may have been caused by increased global tourism, but others are due to armed conflict and unstable economic and political climates in some countries. Areas with high tourist activities in East, Central, Southern and parts of West Africa have high rates of HIV infection. For instance, the tourist areas of East Africa were the first to be hit by the AIDS crisis, as well as zones of armed conflict Uganda.1 Sexually active HIV positive individuals who do not show the symptoms of the disease facilitate the spread of AIDS to others when they travel. Some of these carriers may knowingly transmit the disease to other partner(s) due to their recklessness, but others may be unaware that they are infected. Whichever the mode of spread, the fact is that many African women have fallen victims to the disease. Africa has the highest number of displaced people due to civil wars in Sierra Leone, Liberia, Congo, Somalia, Rwanda, Burundi, Angola, and Uganda. They constitute a higher percentage of the refugees, they are migrant workers, and professionals, often migrating as a result of economic and political instabilities in their homelands. Women have figured prominently in relocating to refugees camps, urban areas and foreign countries (United Nations, POP, 1998). According to the United Nation data, women migrate as much as men. Women, migrants, especially ones migrating for work have substantially contributed to population increase in large urban centers. In as much as African women are part of this movement, they too have suffered from the ravages of high rates of HIV/AIDS infection.
Another factor is the dilapidated health care systems in many countries that are insufficient to combat conventional diseases much more a major health care catastrophe as AIDS. In terms of budget allocation, the World Bank’s figure for Sub-Sahara Africa is about $34 per individual. In Nigeria and Kenya, the budget is even less. Compared to the United States with an average budget of $2,485, the low health care budget of African countries drastically affects the quality of health care delivery (World Bank, 2000). Closely connected to this factor is that these countries cannot afford to purchase expensive drugs known to prolong the lives of the affected patients. As the death toll mounts, we can see clearly that the lack of efficient health care systems is a contributory factor to the prevalence of the epidemic and the subsequent high mortality cases.
Further aggravating the health care problem, is the fact that the hardest hit areas have virtually little or no preventive strategies, such as sex education. Most people are still unaware as to how the disease spreads from one person to another and they become infected due to lack of knowledge. Because sexual relationship between partners is not openly discussed, little is known about the implications and linkage of unprotected sex to the spread of HIV. In addition, there are instances where due to of lack of knowledge people resort to traditional healers to cure their ailments, a clearly inappropriate course of treatment. False hopes are raised as mythic treatments further aggravating the situation as HIV positive men carry out a native doctor’s prescribed cure by “having sex with a virgin.”
Furthermore, due to the problems of poverty and underemployment, many young African women and have become as sex workers. To protect their identities, some of them travel to another locations such as, other urban areas and foreign countries. Areas with high prostitution activities such as bus/truck stops is also, associated with high rate of HIV/AIDS infection. As a matter of fact, many truckers have multiple sexual partners and because of their trips to diverse locations, they have become a major source of transmission of HIV/AIDS infections in Africa. They contract and spread AIDS among sex workers along the highways. They even spread this disease to their wives at home. For example, the Nigerian press has reported that Makurdi women working as prostitutes in Shagamu, a major truck stop in Nigeria, are abandoning their posts and returning home to die of AIDS. Many of the sex workers overseas return home upon becoming infected with the HIV virus. This development is known in Nigeria as the “Benin girls phenomenon.” Some of these sex workers have had children, and have spread the disease to the next generations thereby further complicating the AIDS crisis in Africa.
The survival of future generation is currently threatened when mothers who are the victims of AIDS infect their babies through placenta or nursing. Mother-to-child transmission (MTCT) of HIV has been earmarked as a major and progressing global emergency. Traditionally, breast-feeding is a widespread practice in Africa. HIV could be communicated to babies through this avenue. Other ways could be through placenta and childbirth. For instance, in 1999, about 570,000 children are infected (Dabis, and Leroy,et. al., 2000). About 3.6 million of the world’s children are infected and 5 million of them have died of AIDS (UN, 2000). High number of these children contracted the disease from their mothers. According to the UN estimate, about 90 percent of these children are born in Africa. The high fertility rate in Africa is associated with high rate of HIV infections and these two factors converge to plague Africa. For instance, in many Southern African countries, pregnant women present 20-30 percent HIV infection rate. Some sections of Botswana have registered rates of between 34 and 43 percent, and Zimbabwe between 59 and 70 percent. The AIDS epidemic has posed a serious threat to the women’s traditional methods of conception, childbirth and nursing. African women and children are at the epicenter of this battle. Therefore, economic and political instability, migration, marriage, heterosexual relationships, prostitution, sexual violence, lack sex education, childbirth and breast-feeding are key factors converging to thrust African women at the epicenter of AIDS epidemic.
The African media, neighbourhood groups and schools are yet to become highly involved in publicizing the problem. Yet, these are vital sectors of socialization and would facilitate the regional educational outreach programs. Until African governments begin to acknowledge the epidemic nature of this disease, and seriously begin to find ways to address the problem, African women will continue to become infected at a rapid pace. For many people desiring to contain the spread of AIDS/HIV in Africa and the globe, teaching and advising the people to alter their sexual behaviour is not sufficient. Citizens must become involved in the decision making process that impact them. Responses to AIDS do not have to originate from the highest echelons of power in the political system involving only policy officials and agencies. Behavioral changes must be actualized through establishing open debates and tolerant divergent view points and tapping into broad ranges of people including the less privileged. The Panos Institute serves as a basket case for utilizing the media to engage in outreach program. Their services could be applied to provide assistance to the African governments in the preventive initiatives to control the spread of HIV/AID in Africa.
In the developing economies, the Panos Institute is involved in producing a wide-range groundwork for the media, non-governmental organizations and governmental organizations for the developing countries. The purpose of the Panos Institute is to encourage and promote interchange of ideas between groups. Its basic functions include producing media briefing materials and regular radio programs under the general headline of “AIDS TODAY.” Such a program gives a fifteen minute taped program which are circulated through 80 radio stations in Africa and other countries. Its basic objectives include the following:
According to the World Health Organization, the Panos initiative is translated into 10 African and Asian languages and circulated around 1500 print media across the globe. This effort is exported to expand the efforts of African Network on HIV/AIDS issues. Such problems include the following:
Panos Institute has given travel grants to journalists to produce their own radio program on AIDS-related matters. On one hand, the limitation of the Panos program lies in the fact that it is produced in English and restricts the non-English spoken components. On the other hand, the advantages of the program are as follows:
It can cover vast critical concerns such as, sex education, prospects for AIDS vaccines, AIDS and young people, vaginal virucides, testing for HIV and the right to know, tuberculosis and HIV, safe blood condom policy, combination therapies and implications, traditional healers, orphans and HIV, employment rights of people with HIV, sex, AIDS and children, HIV in prison, breast feeding and HIV, and criminal law and HIV (UNAIDS/WHO, 1998).
The Panos programs have aired in Niger, Southern Africa, East Africa, and the Horn of Africa. The effectiveness of the Panos program is a suggested area for further research. Nonetheless, one cannot underestimate the influence of the mass media in exchange of information and mobilization of the masses to achieve a given policy agenda. African governments should effectively use the media in the education of their citizens about the dangers of HIV/AIDS crisis.
Even though, most of the discussions on the spread of AIDS have centered on the victims of this disease, the problem of AIDS is deeper-going affecting the entire region socially, physically and economically. Many people afflicted by the disease have family members bearing the burden of care giving, in addition to overseeing many other obligations. Most of these caregivers are women. This section include implications of parental AIDS patients on children, the effect of adult children’s AIDS on Parents, demographic impacts of AIDS/HIV, and how the prevalence of HIV/AIDS affect grandparents, and communities at large.
By the end of the 2000, over 10 million children under the age of 15 years will have lost either, or both parents to AIDS (UNAIDS,1999). AIDS is creating a generation of orphans numbering about 10 millions in Africa. Chances are high for children to become street children as a result of their mothers’ death, as opposed to fathers. But the loss of both parents to AIDS creates a generation of orphans with drastic consequences on Africa as a whole. It creates another dimension of problems leading to the devaluation of productive citizens and strong social values that could have been inculcated were their parents alive. South Africa will have about 2.5 million orphans by 2010 (Whitelaw ,2000). The incident of AIDS in the region has left millions of African children stranded. The literacy rate of these children declines as a result of dropping out of schools due to financial crisis and lack of mentorship. These orphans’ are confronted with stigmatization, prejudice, malnutrition, poverty, and social reclusiveness. Such a condition may create a major psychosocial trauma on the children. Furthermore, it might expose them to sexual and physical violence and aberrations of child labor. They also, may lose their traditional inheritance due to the death of their parents as no one would fight for their rights. Moreover, many of these orphans drop out of school, as they have no one to sponsor their education. Many African countries still lack free primary and secondary education and these children suffer from illiteracy. Furthermore, as orphans these children may suffer from neglect and malnutrition, which further affect their lifestyles and deprive Africa of her precious human resources
A state of emergency is created in the communities with the pandemic AIDS crisis. African countries with a high human AIDS toll, experience a shortage of human and fiscal resources to alleviate the problems. Sometimes in Africa, due to the unavailability of parents to raise these children, they end up in orphanages, or live with relatives who may take over the task of raising them with limited resources. Some of these children may become street children, which further shortchanges the systems. Kenya has a high incidence of street children and many of them left abusive foster parents and orphanages and become street children. For instance, about 100,000 children are estimated to be street kids in Lusaka, Zambia due to lose of their parents. They may become involved in drug trafficking, or engage in crime and prostitution as a way of survival. About one-third of teenagers and minors fall under this category. Consequently, Africa is dealing with a lost generation--compose of uneducated, vulnerable and disadvantaged children lacking the prospects of a bright future. Therefore, the impact of parental AIDS on children should be carefully evaluated. Because, a high number of children who lost their parents, particularly their mothers have high chances of becoming homeless, impoverished, uneducated, engaging in criminal conducts, and contracting AIDS and reducing their life expectancy. These factors combine to deprive Africa of a steady supply of productive and reproductive resources and short changes her capacity to attain sustainable development.
Adults can be affected by AIDS epidemic in many ways. The parents may incur additional financial obligations due to health care costs and the supply of material assistance to their AIDS afflicted adult children. Furthermore, these parents may begin to raise their grandchildren on their own. Compared to other continents, Africa has the lowest rate of life expectancy as a result of the AIDS epidemics. The incidents of AIDS on adult children impose additional burden on their surviving parents already on the threshold of aging. Southern African is experiencing a high influx of grandmothers raising their grandchildren due to the AIDS crisis. The health condition and subsequent death of their adult children’s rob them of the traditional care giving rendered by children to their parents. Therefore the complications of AIDS on the adult children may overwhelm their parents, the duration and degenerative nature of the ailment is taken into consideration. The taboo/stigma attached to the disease and the untimely death due to the disease may combine to affect the victims’ parents. Their parents care for the majority of AIDS victims in Africa. It is estimated that about 10 percent of affected parents fall under this category and the actual number may be higher due to paucity of data in Africa. Again, African women are more likely to render this type of care than their men are.
Due to the high incidents of AIDS/HIV in many parts of Sub-Sahara Africa, there is a resurgence of infectious diseases in the region such as tuberculosis which kills about 3.3 million people annually (McNicholl, 1998). Opportunistic infections, such as bacteria or viral infections are acquired because the AIDS victims are immuno-compromised. The pneumocystis carnii (PCP) triggers infection causing pneumonia because the CD4 count of the patient falls below 200 and the viral load (the amount of HIV in the blood) simultaneously increases as the CD4 count reduces. The cyclomegalo virus (CMV), mycobactrium avium Complex (MAC) plague, toxoplasmosis (cat urine) fungal infections, herpes, candidiasis (oral thrush) are classified under these types of infections (Wachter, 2000). Some of these infections, such as TB and other viral infections could easily be spread to other people which further impact on the cost and quality of care and sustainable development of Africa. In 1998, there were about 7.4 million new cases of TB and women constitute the majority of these cases. TB affects poorer and young people and fatality rates may be higher for African women.
According to an epidemiologist, four major consequences manifest as a result of the upsurge of infectious diseases including AIDS, poverty, unemployment, and alcoholism (Feldmeier, 1998). In Namibia for instance, there is 50 percent unemployment. Consequently, there is a pattern of migration from local urban areas and many people dwell in slums, which serve as a breeding ground for infectious diseases. Alcoholism is rampant in the urban slums especially in Windhoek region. Reports suggested that sexual behaviour of the young and unemployed migrants tend to alter with high incidents of promiscuity and prostitution that carry the adverse consequences of contracting HIV infection. Also, there is an outbreak of tuberculosis in the area that is closely linked to the spread of AIDS. About 150,000 to 160,000 people are infected by HIV in the areas and half of the TB patients have HIV infections. Likewise in Zambia, which reported that seven of every 10 AIDS cases are infected with TB. (Feldmeier, 1998). Consequently, the AIDS/HIV epidemic is responsible for the upsurge of infectious diseases that are associated with poverty, promiscuity, and environmental conditions. As many African women are poor, they stand a higher chance of contracting and dying as a result of communicable diseases. The existence of these diseases robs African of the productive sector that is supposed to sustain African development.
In the field of education for instance, the impact of AIDS on teachers is pronounced. In South Africa, about one-third of teachers may be HIV positive. Statistics indicate that in Zambia, two teachers are dying for everyone graduating from training institution. The adverse impact of this spread of AIDS on education stems from the fact that these teachers play a critical part in molding the future of the younger generations. With the AIDS pandemic, the absence of these men and women in the classroom carry a heavy toll on Africa.
The shortage of human resources due to incidents of AIDS have forced companies such as British Petroleum and Barclays Bank to embark on the strategy of employing 2 people for a skilled position as a way of ensuring the availability of employees in the event of AIDS-related deaths (Whitelaw, 2000). Such protective mechanism on the part of these companies drives home the adverse impacts of AIDS as the cost of doing business rises astronomically. It is foreseeable that many companies may begin to fold up and leave, or may invite none indigenous people to fill up existing vacancies which further undermines African countries capability to participate in the global economy. According to the UN data, the gender gap in elementary and secondary education is narrowing, but with epidemic of AIDS more African women than men may lack the necessary education to sustain themselves and their environment.
Sub-Sahara Africa, which has one of the highest fertility rates in the world with an annual growth rate of 3 percent, is experiencing a downward trend in life expectancy. According to US Agency for International Development (USAID), by 2003, the following countries are expected to experience negative population growth. They include Zimbabwe, South Africa, and Botswana. Many other African countries such as Malawi, Namibia, Zambia and Swaziland may have a zero population growth as a result of prevalence of HIV/AID crisis (Stephenson, 2000). A study conducted in 1999 suggests the following trends: in Zimbabwe, 26 percent of the adult population is infected. In Zambia, Swaziland, and Namibia, the estimates stands at 18-20 percent. In South Africa, about 22 percent are infected out of 43 million people. Nine percent of the population of Nigeria, Tanzania and Ethiopia are infected (Brown and Halweil, 1999). By 2000, UNAIDS data indicated an upward surge of AIDS cases in Africa. For instance, Botswana had about 36 percent adult infection rate and Lesotho, Zimbabwe, Swaziland, Namibia and South Africa account for over 20 percent HIV/AIDS cases (Stephenson, 2000). The infection rates are expected to continue to rise creating further shortage of human resources, because death rate exceeds the birth rate. Botswana life expectancy has dropped from 61 years in 1990 to 44 years in 1999. Estimates further projected a further decline to 39 years which holds true for Botswana in the year 2000. For Zambia, Mozambique, Malawi and Rwanda the life expectancy is less than 40 years in the year 2000 (Stephenson, 2000). The life expectancy for Ivory Coast will decline from 62 to 43 years; Mozambique from 53 to 31; Tanzania from 73 to 33 years; South Africa from 68 to 38 years and Nigeria from 61 to 47 years (Haleil and Brown, 1999). The gender- dimension of the impact of AIDS crisis on population growth stems on the fact that women reproduce. When they are infected with this deadly disease, the consequence is death, and/or it increases possibility of mother-child transmission of the disease. In this sense, African population is affected when the health of African women is drastically challenged.
As the AIDS epidemic increases, it overwhelms the health care systems in many nations in Africa. The estimated cost of supplying antiviral treatment would rise higher than the GNP of these states. The antiviral treatment is crucial because it is the standard procedure utilized in controlling the symptoms of AIDS. It enhances the quality of life and delays the death of victims in areas such as, Uganda, Tanzania, Malawi and Mozambique. In many African hospitals, a major segment of beds are assigned to the AIDS victims. For example, 70 percent of hospital beds in South Africa are occupied by these patients (Halweil and Brown, 1999). Due to high incidence of AIDS and on African countries financial incapability to deliver quality health care.
Two types of incidences of infections are reported in Africa: HIV-1 and HIV-2 or dual reactive patients presenting HIV-1/HIV-2 (Weiseman, 1999, and De Cock, 1996). The HIV-2 infections epidemiologically related to West Africa, and its variants are found in Central Africa. All these strains have major public health implications (Candotti, 2000). Due to the expensive nature of AIDS treatment regimen, many victims of this disease could not afford to pay for treatment. As of 1997, a new cocktail of drugs can clear up the virus in the majority of cases, but unfortunately, one year supply, costs about 10,000 pounds sterling. Only a handful of people can afford such a treatment (New Statesman, 1998). As a result, the AIDS lobbies have successfully pressured the drug companies to reduce the cost. UN in conjunction with the World Bank intervened to address the problem. For example, drugs were made available to 4000 people in Ivory Coast at reduced prices. Similar trial efforts were successfully duplicated in Senegal and Uganda. These two countries have successfully reduced the incidence of AIDS/HIV infections due to their commitment to prevention at the grassroots. This is gradually expanding to include other countries but home governments have failed to extend it to the masses. Senegal, for instance, was able to establish mass education, by mobilizing and working with the Moslem imams and Christian clergies, and was successful. Therefore, governmental intervention would help to reduce the incidence of AIDS in Africa.
The classic presentation of AIDS includes the following: pyrexia, or high temperature, TB, abnormal weight lose, Kaposis sarcoma, eczema, rash, oral thrush, diarrhea. Usually the patients present multiple symptoms. Even though, there is a lack of a standardized AIDS testing in Nigeria, Elisa is the major test utilized. Most of these tests are performed at the teaching hospitals and private laboratories. But there are controversies relating to such tests especially when some tests confirm the AIDS/HIV and others contradict it. The discrepancies may stem from lack of skilled personnel, outdated equipment, carelessness of workers, etc. In terms of disclosure, it is reported that many private hospitals would not reveal to their patients the nature of their diseases for fear of losing them to competitors (Termmerman M. 1995) So, doctors manage the opportunistic infections symptomatically.
In many countries in Africa, AIDS is still regarded as a taboo and AIDS testing is not routinely conducted, hence people are not fully informed as to how the disease is transmitted and the mass media are not publicizing the epidemic nature of the disease. Condoms are not widely circulated and sometimes, people unknowingly transmit AIDS mainly through heterosexual relationships. By the time the patient senses that something is wrong and goes to hospital, he/she has developed full-blown AIDS. Due to lack of necessary drugs in most hospitals, the only alternative is to mange the disease by treating only the symptoms and discharging the patients. Such a standpoint hastens the debilitating nature of the disease , which quickly results in death.
In most African countries, doctors are underpaid and that affects the quality of care they deliver. In Nigeria, doctors working both at government and private are forcing patients to pay prior to receiving treatments. Many doctors who have their own private practices fail to disclose to their patients the nature and type of their ailments for fear that they many not come in for further treatment. In fact, some are accused of relying on placebos to treat patients and still charge the full course of treatments. Many private hospitals terminate treatments due to their patients’ inability to pay and this may send patients to early grave. This had led to the emergence of “good Samaritan doctors,” who raise funds to support their patients and establish blood drive to carry necessary transfusions. But the practice is not wide spread given the time and cost involved.
Policy prescriptions in relation to prevention and control of HIV/AIDS surmount the current capacity of African governments to implement. Therefore, my suggestions are for these governments to incrementally implement a number of these critical policy concerns already in existence. AIDS affects all groups in Africa, nonetheless, African women as a group are the most affected. Because of their reproductive and productive capabilities, these women hold the key to contemporary human existence in Africa as we know it. Yet, this is the group most threatened by the epidemic in the system. If not controlled the challenges of the AIDS pandemic will wipe out a major portion of the African population. A number of factors combine to account for the spread of AIDS. They include but are not restricted to lack of quality sex education, men’s irresponsible behaviour, prostitution, sexual violence and slavery, migration, poverty, economic and political instabilities, pre and perinatal transmission, etc. As earlier discussed, The prevalence of the disease has spurred all kinds of problems which in have gender implications. They include the following: the prevalence of contagious diseases, upsurge in the number of street children, declining quality and life expectancy, negative population growth, rise in illiteracy rate, overwhelmed care delivery systems, upsurge in grandparents serving as care givers to their grand children, rise in the number of orphans, and increasing mortality of women due to the epidemic.
The sexual spread of HIV can be stopped by mutual monogamy, abstinence, or by using condoms. Sex education must be geared toward encouraging young girls and women to hold off first sexual relation as a protective strategy. For instance, in Uganda, a ten year long public education campaign aimed at young individuals from 1987 to 1997, succeeded in curtailing new HIV infections from 239,000 cases, down to 57,000 (UN: World’s Women, 2000). Such an initiative as the age of intimacy rose. reduced HIV prevalence among pregnant women in the area. African governments must embark on measures to reduce the incidence of STI, which would diminish the risk of women infected with HIV. They could encourage the manufacturing, and distribution of female contraceptive devices such as female condoms and other preventive mechanisms. Calcutta India in 1994 achieved a reduction of HIV/AIDS infection rates as a result these kinds of preventive programs (Madu, 2000).
In Africa, AIDS is mainly transmitted through heterosexual contact, blood transfusion, perinatal transmission, and contaminated surgical instruments. Blood transmission can be prevented by establishing reliable screening of blood products and by not reusing needles and sterilization of surgical instruments. Mother-to-child transmission can be reduced by half or more short courses of antiviral drugs (Castetbon, Leroy, et. al, 2000). Infected African women choosing to breast-feed must undergo counseling. Breast milk alternatives should be provided to these women at affordable rates. African policymakers must become highly involved in public education and research. Governments must prioritize their options and health care system and delivery should receive top most priority in their planning schemes. They must formulate preventive programs and encourage the mass media to publicize and educate the masses, particularly African women being the most affected group. African leaders must seriously explore ways to provide economic and political stability as sustainable and developmental mechanisms.
Limited resources and the crushing burden of poverty in many parts of Africa constitute formidable challenges in the control of HIV infection. People already infected can be helped through providing treatment with life-saving drugs, but the high cost of these drugs put this treatment out of reach of most of the people in Sub-Sahara Africa. It is vital to develop new antiviral drugs that are easier to take, and have fewer side effects, and are less expensive, so that millions of people can benefit from them.
Finally, many African health care practitioners must be sensitized as to the nature of the pandemic AIDS crisis. They must be provided with incentives to encourage proper health care delivery. Africans in diaspora must begin to contribute funds to help alleviate the costs of health care delivery. Governments must establish a reward system for doctors to encourage effective health care delivery. Drugs must be made widely available at a reduced cost to all and subsidized cost-efficient medical treatments should be provided. Both private and public African hospitals should discontinue their practices of pre-charging their patients prior to delivering care. Effective health insurance programs will eliminate this practice. Payment by barter may be encouraged in cases where patients could not afford treatments. The use of placebos to treat HIV/AIDS patients must be discontinued at all costs. There is no end in sight to AIDS crisis in Africa. But by working together, African governments, health care workers, and others have the power to reverse this tidal wave.
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Citation Format
Umerah- Udezulu, Ifeyinwa (2001). RESENSITIZING AFRICAN HEALTH CARE AND POLICY PRACTITIONERS: THE GENDERED NATURE OF AIDS EPIDEMICS IN AFRICA. Jenda: A Journal of Culture and African Women Studies: 1, 2.